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Gero > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Beers Criteria

A

listing of drugs that carry high risks for older adults and criteria for potentially inappropriate medication use in older adults

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2
Q

Biological Half life

A

the time necessary for half of a drug to be excreted from the body

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3
Q

Pharmacokinetics

A

refers to the absorption, distribution, metabolism, and excretion of drugs

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4
Q

Pharmacodynamics

A

refers to the biologic and therapeutic effects of drugs at the site of action or on the target organ

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5
Q

Polypharmacy

A

use of multiple medications

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6
Q

Age-related changes create

A

Pharmacokinetics

Pharmocodynamics

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7
Q

Most common mediation?

A

Cardiovascular agents

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8
Q

Decreased intracellular fluid, increased gastric pH, decreased gastric blood flow and motility, reduced cardiac output and circulation, and slower metabolism can slow drug absorption.

A

True

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9
Q

Distribution changes in older adults

A
  1. changes in circulation
  2. changes in membrane permeability
  3. body temperature
  4. tissue structure
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10
Q

If your liver is not functioning.. you will not

A

LIVE

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11
Q

Liver influences what?

A

Drug detoxification and excretion

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12
Q

As you get older what is the central nervous system increasingly sensitive to

A
  1. alcohol
  2. narcotics
  3. bromides
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13
Q

What is an early identifier to adverse reactions to medications in older adults ?

A

Change in mental status

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14
Q

Varying degrees of mental dysfunction are often the early signs of adverse reactions to commonly prescribed medications for older adults.

A

True

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15
Q

Most common route to administering drugs ?

A

Oral

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16
Q

Fastest route of drug administration?

A

IV

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17
Q

Aspirin can cause?

A

Intestinal bleeding

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18
Q

Acetaminophen

A

lacks anti inflammatory properties can cause liver failure ( hepatic necrosis)

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19
Q

Short Acting Opioids are for ?

A

Mild/ Moderate pain can cause constipation

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20
Q

Long acting opioids

A

Severe pain can cause constipation and gastric immobility

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21
Q

What is acetaminophen commonly used to treat

A

osteoarthritis

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22
Q

What is acetaminophen used for ?

A

Mild to Moderate Pain

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23
Q

What should the daily does of acetaminophen not exceed ?

A

4,000 mg

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24
Q

What should not be used for people who have liver disease ?

A

Acetaminophen

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25
Q

What is one thing you should avoid doing within two hours go giving an antacid?

A

Avoid administering any other medications within two hour to prevent the antacid from interfering with drug absorption

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26
Q

What can excessive antibiotic use lead to ?

A

antibiotic resistant bacteria

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27
Q

Which of the following classifications of antibiotics requires close monitoring for hearing loss and renal failure ?

A

Amino-glycosides

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28
Q

Why do ahminoglycosides require close monitoring

A

because they can increase the risk of hearing loss and renal failure

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29
Q

What are the two main Anticoagulants

A

Heparin and Coumarin

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30
Q

When must you administer anticoagulants?

A

You must administer anticoagulants at the same time to maintain a constant blood level

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31
Q

What do anticoagulants put you at a higher risk for

A

Bleeding

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32
Q

What foods can reduce the effectiveness of anticoagulants

A

those foods rich in vitamin K .

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33
Q

Mango and Papaya can increase what ?

A

INR

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34
Q

Why should patients avoid aspirin with anticoagulants

A

it can interfere with platelet aggregation and it can cause bleeding

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35
Q

What are some possible side effects of anticoagulants

A 
bruising 
pallor 
weakness 
jaundice
confusion
agitation
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36
Q

What can anticoagulants depress

A

psychomotor activity

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37
Q

Should anticonvulsants be stopped abruptly

A

NO

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38
Q

Can grapefruit juice be ingested while taking

A

No it increases the risk of toxicity

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39
Q

what patients should be monitored closely while taking anticonvulsants

A

those with glaucoma, CAD, prostate disease

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40
Q

What can anticonvulsants cause

A

photosensitivity

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41
Q

What is the most common antihypertensive drug

A

diuretics
beta- blockers
calcium channel blockers

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42
Q

What is important to monitor when taking antihypertensives drugs

A

monitoring potassium

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43
Q

What do NSAID’s have ?

A

A narrow therapeutic window

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44
Q

NSAID’s have to be taken with what

A

food or a glass of mild, to reduce GI irritation

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45
Q

What should be monitored when taking cholesterol lowering drugs

A

ensure that patients receive liver function tests

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46
Q

Cholinesterase Inhibitors

A

Aricept, Exelon, and Razadyne

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47
Q

What are some signs of digoxin toxicity

A

bradycardia, diarrhea, anorexia, nausea, and vommiting

48
Q

Which patients are more susceptible to digoxin toxicity

A

Those with hypokalemia

49
Q

Main diuretic types

A

Thizaides , loop diuretics, potassium sparing diuretics

50
Q

What can diuretics worsen in patients ?

A

existing liver disease, renal disease, gout, and pancreatitis and raise blood glucose in diabetics

51
Q

What should be routinely tested for those who are on diuretics

A

Serum electrolytes, glucose, and BUN

52
Q

Types of Laxatives

A

Bulk formers, stol softeners, hyperosmolars, stimuleren, and lubricants

53
Q

What is important to educated patients on when they are taking laxatives

A

to maintain a good fluid intake

54
Q

What are some examples of psychoactive drugs

A

Anti-anxiety drugs ( anxiolytics)
Antidepressants
Antipsycholtics
Sedatives/ hypnotic

55
Q

What is an uncomfortable side effect of antidepressants

A

Mouth dryness

56
Q

What classification of antidepressants have the most issues in older adults

A

Trycyclic antidepressants

57
Q

Older adults are more sensitive to anticholinergic effects of medications, what do the side effects include

A

dry mouth, constipation, urinary retention, blurred vision, and insomnia

58
Q

What are the two things that patients are at risk for the most when taking antipsychotics

A

falls due to hypotensive effects, and constipation

59
Q

What is important to evaluate when sedatives are used

A

Insomnia

60
Q

Neuropathic Pain

A

Occurs from abnormal processing of sensory stimuli by the central or peripheral nervous system

61
Q

Nociceptive Pain

A

Arises from mechanical, thermal, or chemical noxious stimuli, can be somatic or visceral (by central or nervous system)

62
Q

Somatic Pain

A

bone of soft tissue masses; localized, throbbing and aching

63
Q

Visceral Pain

A

disorders that cause generalized or referred pain, deep, and aching

64
Q

Neuropathic pain description

A

Sharp, stabbing, tingling, burning, onset of high intensity

65
Q

Somatic Pain description

A

well ,localized, throbbing, pr aching

66
Q

Complications of Unrelieved Pain

A

a. Limited mobility
b. Develop pressure ulcers
c. Pneumonia
d. Constipation
e. Poor appetite
f. Depression, hopelessness
g. Spiritual distress

67
Q

Mr. D suffers from late stage dementia. Which behavior indicates that he is in pain?

A

a. Agitation and decreased socialization

68
Q

What are some complementary therapies

A

Aromatherapy, herbal, and supplements

69
Q

Which mediation, commonly used for pain, is contraindicated in the older adult related to potential side effects

A

Propoxyphene ( Darvocet)

70
Q

Why is Darvocet contraindicated for older adults

A

because it has the potential for CNS and Cardiac toxicity

71
Q

Macroenvironment:

A

elements in the larger world that affect groups of people or entire populations

72
Q

Microenvironment:

A

the immediate surroundings with which a person closely interacts

73
Q

Restraint

A

anything that restricts movement, can be physical or chemical

74
Q

Microenvironment

A

immediate surroundings

75
Q

Macroenviornment

A

elements in larger world

76
Q

Recommended room temperature

A

75 degrees

77
Q

Taking more than one drug can increase the risk of what

A

Drug/ food interactions

78
Q

Ginkgo Biloba

A

anticoagulant effect, irritability, restlessness, insomnia, nausea, vommiting, diarrhea, and increase effects of anticoagulants

79
Q

Ginseng

A

Can increase blood pressure and insomnia

80
Q

St.Johns Worth

A

acts as monamine oxidase inhibitor , hypertension, photosensitivity, nausea and vommiting

81
Q

What conditions can decrease the metabolism of drugs

A

dehydration, hyperthermia, immobility, and liver disease

82
Q

How is creatinine clearance calculated

A

age, weight, and serum

83
Q

Pharmacodynamics

A

the biologic therapeutic effect of drugs at the site of action or on the target organs

84
Q

Signs and symptoms of adverse reactions…

A

Differ in older person

85
Q

A prolonged time may be required for…

A

adverse reaction in older adults

86
Q

Can a drugs adverse reaction be demonstrated even after the drug has been discontinued

A

Yes

87
Q

can adverse reactions develop suddenly

A

yes the patient can be on the drug for a long period of time before reactions occur

88
Q

What is an early symptom of adverse reactions

A

mental dysfunction

89
Q

inappropriate drug to use in adults

A

Pentazocine

90
Q

What is important to ensure that oral medications achieve full benefit

A

Encourage oral hygiene, ample fluids, and proper positioning for swallowing

91
Q

What type of tablets should not be crushed

A

enteric coated and sustained release tablets

92
Q

What is one of the risk factors or medication errors

A

Cognitive impairment

93
Q

What is the mold widely used pain medication in older adults

A

Analgesics

94
Q

What is the most common NSAID in older adults

A

Aspirin

95
Q

What are some secondary infections from antibiotic therapy that can cause discomfort

A

oral thrush
colitis
vaginitis

96
Q

What are some additional things that anticonvulsants can be used to treat

A

bipolar disorders, neuropathic pain, migraine prevention

97
Q

What do beta blockers stop

A

the effects of sympathetic division

98
Q

What do beta blockers side effects include

A

dizziness, fainting, Brady cardia and CHF

99
Q

What is bulk formers intentions

A

to absorb fluid in the intestines

100
Q

Why is poly pharmacy a concern in the elderly

A

metabolic changed, reduced drug clearance

101
Q

What is the risk of polypharmacy

A

Increased healthcare costs
Drug interactions
medication non adherence

102
Q

What are the causes of poly pharmacy

A

Demographic factors
health factors
access to healthcare

103
Q

What is meant by the term poly pharmacy

A

multiple medications taken by patients

two medications at a time to 18, or to more medications than clinically necessary

104
Q

How is poly pharmacy treated

A
  1. obtain accurate medication and medical history
  2. link each prescribed medication a disease state
  3. reconcile medications upon any discharge from hospital of SNF
105
Q

The nurse provides instructions about the medication safety to the older adult. Which instruction is appropriate

A

C. Ask healthcare provider to describe the purpose of the medications

106
Q

An older adult client who is cognitivley impaired is demonstrating signs of being in pain . How should the nurse evaluate the patients pain level
A. Ask the client to numerically rate the pain
B. Observe the client over the next several hours
c. provide the patient with a vigil analogue scale to gauge the pain
d. go through the questionnaire with the client

A

C. provide the patient with a vigil analogy scale to gauge the pain

107
Q

An older client has difficulty swallowing oral medications and sometimes spits them out after the nurse leaves the patients room. which action should the nurse take to ensure the patient takes the medication ?
A. Crush any large or enteric coated tablets
B. prescribe liquid or suppository forms of the medications
C. give the client ample fluids to make swallowing easier
D. having the client hold the medicine in the mouth until being able to swallow

A

C. give the client ample fluids to make swallowing easier

108
Q

The nurse is performing a home visit to an older client who has a history of obesity, and poor controlled hypertension. Which assessment finding would alert the nurse to possibility of a problem
A. the patient has started taking st. johns wort to increase stamina and concentration
B. the client has an increasing intake of green tea to obtain more antioxidants
c. the client has begun low does aspirin for the prevention of cardiac disease
D. the client takes insulin injections x3 for treatment of type 1 diabetes

A

A. the patient has started taking st. johns wort to increase stamina and concentration

109
Q

an older female patient states she has been taking 1 mg of lorazepam at bedtime , when experiencing episodes of anxiety . Which response by the nurse would be most appropriate?
A. have you ever been diagnosed with a condition called generalized anxiety disorder
B. have you considered other methods beyond medication to help you sleep and to relieve anxiety
C. the drug can lead to problems with coordination that may lead to Parkinson’s disease
D. drugs like this have been shown to be inappropriate and ineffective

A

B. have you considered other methods beyond medication to help you sleep and to relieve anxiety

110
Q

A nurse understands that poly-pharmacy can lead to

a. adverse drug reactions
b. drug dependency
c. lack of effective on quality of life
d. herbal remedies

A

A. adverse drug reactions

111
Q 
The gerontological nurse knows that the most commonly used drugs in the elderly include which of the following. SATA 
A. Anti-hypertensives 
B. Analgesics 
C. Antibiotics 
D. Antacids
A

A,B,C

112
Q

A medication is effected by taking with a full stomach of fatty foods, an antacid and bed rest . What base of pharmo-kinetics is be effected ?

A

Absorption

113
Q

When the 70 year old women complains “ I weigh the same as I did when I wore a size ten, and now I can barely squeeze into a size 16” the nurse explains which of the following
A. post menopausal women gain weight as it relates to calcium
B. metabolism in the older adult creates increased adipose tissue
c. kyphosis causes a re distribution of weight
d. denial can be very powerful in how a person perceives their weight

A

metabolism in the older adult creates increased adipose tissue

114
Q 
An elderly patient is prescribed digoxin six months later the patient comes in for a checkup with the provider . Her digoxin levels are normal. what would the longterm nurse expect the provider to do? 
A. increase the dose 
B. decrease patient monitoring 
c. decrease the dose 
D. discontinue the medication
A

Decrease monitoring of the patient

115
Q

A patient has failed to lower their cholesterol level in spite of attempting to modify their lifestyle for the past six months . What agent does a nurse anticipate will be initiated this time ?

A

Statins

116
Q

Which single drug class is known to be most effective I reducing the major types of hyper limpedemia

A

Statins

117
Q

The nurse knows that what drug is recommended for Alzheimers treatment ?

A

Namenda
Aricept
Exelon

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